Managing Binge Eating, from CBT to Apps

Binge eating has recently been identified as an eating disorder that is twice as common as bulimia nervosa.

In response, Drexel University researchers are testing two new treatment methods to help people reduce binge-eating behavior.

The first intervention is the development of a smartphone app that will track users’ individual patterns of eating and binge eating behavior and alert them at times when they are at risk for binge behaviors.

The app will also have a comprehensive suite of other features.

Another treatment is a new, evidence-based approach to small-group behavioral therapy that will equip patients with psychological tools that may help them adhere to, and benefit from, standard treatments for binge eating disorder.

Binge eating disorder, characterized by periods of eating objectively large amounts of food, is “associated with a great deal of clinical distress,” said psychologist Dr. Evan Forman.

Experts say that people who engage in binge eating behavior may feel ashamed, out of control and isolated because they may not know others with the disorder, or even know they have a clinically recognized disorder.

Currently, the best method for addressing binge eating is cognitive behavioral therapy (CBT), an intervention that leads to remission for only between 50-60 percent of individuals.

“It could be improved,” Forman said. “These two studies are an attempt to improve treatments for binge eating.”

Among binge eaters, “there is a cycle of sorts – mounting pressure toward a binge episode, with certain triggers that make it more likely that a binge episode will occur,” Forman said.

The “TakeControl” mobile phone app is designed to provide support in real time, at the moment the trigger occurs.

In the app, users can record their binge-eating activity and urges, multiple mood states and whether or not they’ve eaten regular meals and taken their prescription medications.

As the app learns about an individual’s patterns of binge-eating behavior and their individual triggers, it can prompt the person with a warning alert when their personal risk is high.

“It could be an emotion like rejection, loneliness, sadness or anxiety, or something external such as passing a certain convenience store, or a time of day or night,” said Forman, who is the principal investigator of the project.

When warned that they are at risk for a binge, or at any time of their own choosing, users can follow the app’s customized interventions to help them in the moment when they need it.

Users of the “TakeControl” app can choose how much and how little of their personal data to enter to help the app help them.

The app also includes learning modules, optional personal goal-setting modules and optional social networking features to connect with others who share this often-isolating disorder.

“Using the data visualization modules, people can chart their behavior patterns over time,” said Stephanie Goldstein, a graduate student in Forman’s lab working on the project.

“This shows people the progress they’ve made and reinforces it. Someone could also learn from the charts, for example, how their binges relate to their anxiety.”

“Most users have their smartphone with them upwards of 20 hours a day, so a mobile app can be a very effective way to monitor behaviors that a physician wouldn’t automatically know about,” said technology consultant Gaurav Naik, M.S., a co-investigator on the project.

Future plans for the app include connections with other technologies for automatic personal data tracking, such as smart pill bottles, web-connected scales and activity bands, as well as existing popular diet and fitness-tracking apps.

Users of the app will also have the option to share their data with their therapist or other clinician, either automatically through a clinician’s portal, or by bringing their exported data to a therapy session.

The other intervention is a review of the way in which CBT is delivered.

“Standard treatment for binge eating disorder is largely behavioral – in that it tells people what to do,” said Dr. Adrienne Juarascio, a postdoctoral fellow in Forman’s lab who is the principal investigator of the in-person treatment study.

“In CBT we ask people to adhere to uncomfortable treatment recommendations, such as eating every three to four hours even when they are concerned about weight gain. Or they might be asked to engage in alternative activities while they are having the urge to binge.

“It can be very difficult to complete these treatment recommendations, no matter how motivated people are.”

Juarascio is now coordinating an experimental treatment program for binge eating disorder that teaches patients psychological strategies to deal with the discomfort associated with traditional treatments.

The 10-session group therapy program integrates the gold-standard cognitive behavioral therapy with another method, acceptance and commitment therapy (ACT) and other third-generation acceptance-based behavioral treatments, to help patients learn to tolerate and accept stressful experiences and distressing thoughts, without engaging in disordered behaviors.

“Different people find it uncomfortable for different reasons,” Forman said. “For example, if someone had binged the night before and thought, ‘There’s no way I’m eating breakfast after that,’ the ACT skills are designed to help the person recognize this feeling of being repulsed by food, and proceed to eat breakfast anyway because consistently eating regular meals is healthier in the long run.”

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Rick Nauert PhD

Dr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.